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PubMed2001

Magnetic resonance imaging of the paranasal sinuses: incidental abnormalities and their relationship to patient symptoms.

OBJECTIVES: Magnetic resonance imaging (MRI) is able to demonstrate a wide range of abnormalities in the paranasal sinuses, which are often reported as incidental findings on scans performed for indications other than the evaluation of paranasal sinus pathology. However, the clinical significance of these findings remains undefined. We present a prospective study that determines the prevalence of abnormalities in the paranasal sinuses in a population undergoing MRI scans for suspected intracranial disease. These findings are correlated with clinical data pertaining to nasal and sinus symptoms. STUDY DESIGN: Prospective, cross-sectional study. METHODS: Patients undergoing MRI scans for suspected intracranial pathology were asked to complete a questionnaire pertaining to symptoms of nasal/sinus pathology. The T2-weighted scans of 86 patients (mean age = 51 years) were then reviewed for evidence of paranasal sinus pathology using a standardized method for evaluation and reporting of results. These results were then correlated with those obtained from the patient questionnaire. RESULTS: Radiologic abnormalities were found in the paranasal sinuses of 33 (38%) patients. Abnormalities were most commonly seen in the ethmoid sinuses (44.8%) followed by the maxillary (38%), sphenoid (14%), and frontal (3%) sinuses. Analysis of the clinical data revealed no significant relationship between the presence of clinical symptoms of nasal and sinus pathology and abnormalities on MRI scan. CONCLUSION: The assessment of inflammatory sinus pathology remains controversial. Based on the results of this study, incidental abnormalities of the paranasal sinuses detected on MRI scan do not appear to be related to clinical symptoms.

Adult↗
PubMedDate not supplied

Increased expression of IL-4, IL-5, IFN-gamma, IL-6, IL-8, and TGF-beta mRNAs in maxillary mucosa of patients with chronic sinusitis.

This study aimed to investigate expression of various cytokine mRNAs, including IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma in maxillary sinus mucosa of patients with chronic sinusitis. Maxillary sinus mucosae of six patients with chronic sinusitis and turbinate mucosae of six healthy subjects were obtained. We performed RT-PCR and Southern blot to examine gene expression of the cytokines IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma in maxillary sinus mucosa and compared the results with cytokine gene expressions in normal turbinate mucosa. IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma mRNAs were expressed more frequently in maxillary sinus mucosa from patients with chronic sinusitis than in normal turbinate mucosa. All the maxillary sinus mucosa specimens revealed relatively higher mean density ratio for each cytokine investigated than did normal turbinate mucosa. IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma mRNAs were expressed simultaneously in maxillary sinus mucosa of chronic sinusitis. These cytokines may be responsible for recruitment of inflammatory cells and for mucosal thickening in chronic sinusitis, and thus chronicity of the disease.

Adult↗
PubMedDate not supplied

Ostial and nasal patency in chronic maxillary sinusitis. A long-term post-treatment study.

In a long-term follow-up study (mean 3.5 years) after treatment of chronic maxillary sinusitis of either rhinogenous or dental origin, 72 sinuses in 66 patients were examined with respect to maxillo-ostial and nasal resistance. In sinusitis of rhinogenous etiology, the mean equivalent ostial diameter was pathologically narrowed (0.89 mm, in patients treated conservatively) whereas it was normal (2.51 mm) in sinusitis of dental etiology (dental treatment in combination with local sinus surgery). In the former group, all sinuses were diseased, compared with 3 out of 23 in the dental group. In order to distinguish between functional and organic ostial stenosis, the patients were also tested after physical exercise. The functional ostial diameter in healthy sinuses was significantly increased in contrast to the diseased sinuses. In one patient the narrow ostium was due to mucosal swelling only, but in the other cases was caused mainly by an organic stenosis. In sinusitis of rhinogenous etiology, a pathologically increased nasal resistance was found in 14.3%, while the corresponding figure in the dental group was 4.3%. Improved sinusal and nasal ventilation, achieved either pharmacologically or, preferably by surgical intervention, seems necessary for successful treatment of chronic maxillary sinusitis.

Adult↗
PubMed2000

[Atypical pneumatization of the paranasal sinus system].

200 CT scans of adult patients with paranasal sinus problems seen in the ENT Department either in the University Hospital in Berne, Switzerland, or in the University Hospital in Munich, Germany, were analysed. Among these we found 9 striking abnormalities of paranasal sinus anatomy. We found abnormalities which caused clinical symptoms, such as an infected concha bullosa, a fine-septated infected maxillary sinus, a pneumosinus dilatans of the frontal sinus with aesthetic problems, and a cellula orbito-ethmoidalis with sinusitis. Some of these abnormalities were found by coincidence, such as a cellula orbito-sphenoidalis and an extreme pneumatisation of the sinus sphenoidalis with a pneumatised processus pterygoideus. 2 cases show the importance of preoperative evaluation of a possible abnormal sinus to avoid operative complications: a sinus sphenoidalis with a pneumatisated clivus and an intraluminal a. carotis interna. The other case involved an optic nerve running free through the sphenoidal sinus. In conclusion we stress the importance of preoperative CT examination and the choice of a coronary or axial CT scan, which reveals any abnormal anatomy of the paranasal sinus pneumatisation and thus increases the safety and efficiency of paranasal sinus surgery.

Adult↗
PubMed1999

Fungal colonization of the paranasal sinuses.

Fungal infection of the paranasal sinuses occur in four primary types: acute invasive (1), chronic invasive (2), chronic fungus ball (3) and allergic fungal sinusitis (4). The first and second form can be fatal and is often found in immunosuppressed patients. The present paper concerns a group of immunocompetent patients with non-invasive chronic sinusitis caused by moulds. Over the period from 1994 to 1998, 132 tissue samples from the paranasal sinuses obtained by endoscopic operation from 117 patients was examined for mycotic infections. The mycological examination was carried out if granulomatous and crumbly material was seen in the sinus by endoscopy (91 times maxillary sinus, 23 times ethmoid sinus, 11 times frontal sinus, 7 times sphenoid sinus). Out of 117 patients 29 were positive (24.9%). From 132 surgical specimens fungi were proved in 34 times (25.7%). The following fungal species were isolated: Aspergillus fumigatus 17 times, other Aspergillus spp 6 times, Alternaria alternata 2, Penicillium rugulosum 1, and moulds without differentiation 5 times. In the histological examination an invasive mycelial growth in the mucous membrane or in the bones was never observable. Our findings represented a commensal colonization of the paranasal sinuses, but not a mycosis. The colonization is evidently assisted by a chronic hypertrophic sinusitis with increased mucus production which impedes the mucociliary clearance. For immunosuppressed patients, however, this situation causes a danger of invasion with fatal consequences.

Alternaria↗
PubMed2001

Herpesvirus type 1-8 in sinus aspirates from HIV-infected patients and immunocompetent individuals.

Sinusitis is frequently occurring in HIV-infected patients, but in a substantial number of cases the etiology is unknown. The purpose of this study was by PCR 1) to determine the prevalence of the eight human herpesviruses in sinus aspirates from 24 HIV-positive/AIDS patients with sinusitis 2) to relate the presence of herpesvirus DNA to clinical and immunological parameters and 3) to compare the prevalence of herpesvirus DNA in sinus aspirates from HIV-infected patients with the prevalence observed in 50 immunocompetent patients with sinusitis. DNA from HSV-1, EBV, CMV and HHV-8 was detected in 8 (33%) of the sinus aspirates from HIV-infected patients. In the immunocompetent patients, one of the herpesviruses, HHV-6, was found in one sinus aspirate. These data indicate that herpesviruses are frequently found in sinus aspirates from HIV-infected patients with sinusitis, whereas they do not seem to be related to clinical signs of sinusitis in immunocompetent individuals. The cause of these discrepancies may be due to uncontrolled reactivation of herpesviruses, which is known to occur in immunocompromised individuals. It remains to be established whether the herpesviruses play a pathogenic role in the development of sinusitis in HIV-infected patients.

Adult↗
PubMed2003

Lipid peroxidation and antioxidant enzyme activities in experimental maxillary sinusitis.

The aims of this study were to assess whether th e increased oxidative stress of acute maxillary sinusitis is reflected by tissue lipid peroxidation and whether the activities of selected antioxidant enzymes are altered during inflammation of the maxillary sinus mucosa. Unilateral rhinosinusitis was induced in 8 rabbits by instillation of 0.2 ml of a killed suspension of Staphylococcus aureus into the right maxillary sinus cavity; control instillation of saline solution into the left maxillary sinus cavity of the same rabbits was also performed. At 7 days post-treatment, mucosal samples were excised from the treated and control sinuses for measurements of superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) and malondialdehyde (MDA). The SOD activity in mucosa of the inflammed sinuses was significantly higher than in control sinus mucosa; GPx activity was significantly lower in the inflammed sinuses than in the controls. No significant differences were found in CAT activities or MDA levels of the inflammed versus the control sinus mucosa. These findings demonstrate that experimental induction of acute maxillary sinusitis in rabbits does not increase lipid peroxidation as evidenced by MDA levels in the sinus mucosa, but does alter the activities of some antioxidant enzymes.

Animals↗
PubMedDate not supplied

Anatomic risk factors for sinus disease: fact or fiction?

BACKGROUND: Sinonasal anatomic variants have been postulated as a risk factor for sinus disease. Therefore, a study was conducted to examine the correlation of sinus disease to septal deviation, concha bullosa, and infraorbital ethmoid cells. METHODS: Two hundred fifty consecutive sinus and orbital computed tomography scans were examined at the University of Virginia over a 2-year period. Coronal, sagittal, and axial views were examined for the presence and size of concha bullosa and infraorbital ethmoid cells. Septal deviations were measured by examining the width of the nasal cavity at the level of the maxillary sinus ostium. The severity of mucosal thickening in the maxillary, ethmoid, and frontal sinuses was recorded. The correlation between mucosal disease of the sinuses to the anatomic variants was then compared. RESULTS: Computed tomography images were reviewed in 250 consecutive studies (500 sides). Of the 500 sides, 67.2% of sides had some level of mucosal thickening. Concha bullosa and infraorbital ethmoid cells were both present in 27% of the sides. Concha bullosa was associated with maxillary sinus disease (p < 0.01). Infraorbital ethmoid cells were associated with both ethmoid (p < 0.05) and maxillary (p < 0.01) mucosal disease. Frontal sinus disease had no significant correlation with these anatomic variants (p > 0.05). For sinuses with infraorbital ethmoid cells or concha bullosa, there were a higher number of diseased sinuses with larger anatomic variants (p < 0.01). Narrow nasal cavities were associated with maxillary sinus disease (p < 0.01). CONCLUSION: Septal deviations, concha bullosa, and infraorbital ethmoid cells, which contribute to the narrowing of the osteomeatal complex, are associated with mucosal disease.

Adolescent↗
PubMed1986

[Osteoma of the sphenoid sinus--report of two cases].

Although osteoma of the paranasal sinus is comparatively common, involvement of the sphenoidal sinus region is extremely rare. Lame reported that a total of twelve cases had been described in the European literature since 1800. Mikaelin, Kulczynski and Dolan, since then, described three cases. This paper deals with two surgical cases of sphenoidal sinus osteoma, reviewing literature on paranasal sinus osteoma and differential diagnosis in the sphenoidal sinus lesion. Case 1. A 20-year-old man was referred to us by an ophthalmologist, complaining of left visual disturbance (visual acuity: 0.02). He had a past history of chronic sinusitis. Neurological examination revealed papilledema on the left. Plain skull X-ray film showed marked destruction of the sphenoidal sinus and tomography demonstrated thinning and expanding of the sella floor with cloudiness in the sphenoidal sinus. CT scan showed an irregular high density mass in the sphenoidal sinus. Sublabial-nasoseptal sphenoidotomy was performed. The sinus was occupied by homogeneous osseous tissue surrounded by thin fibrous tissue. The osseous part was removed as much as possible by a high speed air drill. Histopathologic examination confirmed mature osteoma. Postoperative course was uneventful and left visual acuity was improved up to 0.06. He is now doing well without recurrence for six months. Case 2. A 59-year-old woman was admitted to our hospital, complaining of acromegaly for ten years. She had a past history of chronic sinusitis, hypertension, diabetes mellitus and left putaminal hemorrhage which was evacuated five months before. She had typical acromegalic features and serum levels of growth hormone was 65.8 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1980

[Ultrasound testing in the diagnosis and management of maxillary sinusitis in children (author's transl)].

A- and B-mode ultrasound testing was used in conjunction with X-ray studies as screening tests for the detection of maxillary sinusitis in 280 children (aged 4-10 years) about to undergo adenoidectomy, and/or tonsillectomy and/or tympanostomy. X-rays were abnormal in 114 (41%) children, while sinus disease with the retention of discharge was diagnosed by ultrasound in 63 (23%) children. These latter children were then treated for ten days with amoxicillin and decongestant (Rinexin). At time of initial surgery, 63 maxillary sinuses (in 43 of the children) were punctured and irrigated. Another group (consisting of 27 sinuses in 20 children) was treated without antral puncture. All children were reexamined after 10, 20 and 30 days with ultrasound and radiography. After 10 days, there was no discharge found in 86% of the sinuses treated by antral puncture and in 85% of the control sinuses. After one month, all sinuses which had been irrigated were found to be free of disease, while three (11%) of the control group contained discharge. However, the healing process in all patients seemed to be slower, as evidenced by sequential sinus X-rays.--We believe that ultrasonic evaluation of the maxillary sinuses is a simple, rapid and reliable method for the diagnosis and followup of maxillary sinusitis in children. With this technique, it is possible to follow the disappearance of residual sinus discharge as well as diagnose cases which need active treatment.

Adenoidectomy↗
PubMed1995

Acute sinusitis.

Acute sinusitis is one of the most commonly observed entities in clinical practice. Despite the frequency of the disease, diagnosis and therapy often remain empiric. Most cases are secondary to sinus ostia obstruction associated with the common cold or allergies. Maxillary sinusitis is most common. Because of the proximity of vital anatomic structures and venous drainage systems, serious complications frequently arise from sphenoid, frontal, and ethmoid sinusitis. Clinical signs and symptoms most helpful in the diagnosis of maxillary sinusitis are the presence of a maxillary toothache, lack of improvement with decongestants, a purulent nasal discharge, cough, purulent secretions observed on nasal examination, abnormal transillumination, and sinus tenderness. Plain film radiographs are helpful, but do not adequately visualize the anterior ethmoid sinuses. Computed tomography provides superior visualization, but cost remains prohibitive for routine cases. Most maxillary sinusitis in adults is secondary to Streptococcus pneumoniae or Hemophilus influenzae. Moroxella catarrhalis is common in children. Staphylococcus aureus is observed more frequently in frontal or sphenoid disease. Most patients with acute sinusitis are treated without microbiological diagnosis and respond well to commonly used oral antimicrobials with activity against the usual pathogens. Complications of sinusitis include meningitis, periorbital infections, subdural empyema, epidural abscess, brains abscess, cavernous sinus thrombosis, and osteomyelitis.

Acute Disease↗
PubMed1993

[Evidence for the existence of chronic ethmoid-maxillary sinusitis in infants under 18 months of age].

Oto-rhino-laryngologists usually deny the existence of infant chronic ethmoido-maxillary sinusitis, generally agreeing that the earliest signs of pneumatization of the maxillary sinuses cannot be observed earlier than 18 months of age. Based upon ten cases we present evidence that this notion of "late sinusal pneumatization" should be re-examined, pneumatized maxillary sinuses being possible as early as 11 months of age. Thus, at that age, radiodiagnosed apneumatosis which is considered as physiological, may express various conditions, such as true anatomical apneumatosis, chronic glue sinusitis, or simple inflammatory sinusitis of the mucous membrane. Because it is impossible to clinically differentiate these different conditions we believe that in some particular cases, a short course of combined corticoid-antibiotics treatment with sinus X ray before and after treatment, may be useful. In case of confirmed sinusitis (sinus visualization after treatment), a secondary preventive treatment may reduce the risk of chronic maxillary sinusitis. We suggest that further studies should be performed in order to better define the reality of chronic ethmoido-maxillary sinusitis in infants younger than 18 months of age, and to study the possible role of a phenomenon of immuno-inflammatory trapping in its pathologenesis.

Age Factors↗
PubMed1998

Tributary venosinus occlusion and septic cavernous sinus thrombosis: CT and MR findings.

PURPOSE: In autopsy reports of patients who died of septic cavernous sinus thrombosis, tributary venosinus occlusion has been a common finding related to intracranial inflammatory complications. The purpose of this article is to illustrate the MR and CT appearance of septic cavernous sinus thrombosis and tributary venous occlusion. METHODS: Over a period of 7 years, eight patients with septic cavernous sinus thrombosis were examined by contrast-enhanced thin-section CT. The CT scans of these eight patients and those of 30 healthy control subjects were assessed independently and subjectively by two blinded readers to ascertain the presence, size, and density of areas of nonopacification within the cavernous sinus and the presence of filling defects and dilation of tributary veins and venous sinuses. In six subjects, MR images supplemented by a contrast-enhanced spoiled gradient-recalled acquisition in the steady state (SPGR) sequence were assessed with respect to the presence of filling defects, expansion, and signal abnormalities within the cavernous sinus and tributary veins and sinuses. The MR and CT findings were compared. RESULTS: The CT studies of the eight patients were consistently differentiated from those of the control subjects by the two readers. Contrast-enhanced CT findings in patients included areas of nonopacification that were present within the cavernous sinus bilaterally in six cases and unilaterally in two. The size of the filling defects exceeded 7 mm in 76% of thrombosed cavernous sinuses compared with 9% of control subjects. The mean density of filling defects in patients differed significantly from those in control subjects. Comparison of the MR and CT findings in six cases showed the contrast-enhanced SPGR sequence to be equivalent to CT with respect to delineation of filling defects. CONCLUSION: Contrast-enhanced high-resolution CT findings indicate that venosinus thrombosis associated with septic cavernous sinus thrombosis is not restricted to the superior ophthalmic vein and is more common than previously assumed. A contrast-enhanced SPGR MR sequence may be used as a reliable alternative to establish the diagnosis of cavernous sinus and tributary venosinus thrombosis.

Adolescent↗
PubMedDate not supplied

Paranasal sinuses in pediatric patients by MRI: normal development and preliminary findings in disease.

A two-part study using medium field strength magnetic resonance imaging (MRI) was designed to describe the normal paranasal sinus development and to provide preliminary criteria for clinical sinus disease. In part I of the study the paranasal sinuses were retrospectively evaluated in 80 infants and children aged 0-17 years undergoing brain MRI for indications both unrelated and related to sinus disease. We developed MRI criteria for independent grading of paranasal sinus development and 'anatomical' sinus disease, i.e., disease as seen by the radiologist. We quantified the variability in extent of sinus pneumatization (a measure of sinus development) in infants and young children. Part II of the study was a double-blind prospective study in 21 patients to correlate 'anatomical' disease with 'clinical' sinus disease. In this limited preliminary study, clinical sinus disease was only seen in the patients with moderate or severe anatomical disease (sensitivity 100%; specificity 100%).

Adolescent↗
PubMed1997

Transoccipital power-based color-coded duplex sonography of cerebral sinuses and veins.

BACKGROUND AND PURPOSE: Power-based transcranial color-coded duplex sonography is a new development for cerebrovascular imaging that is suited for detection of slow velocities. The purpose of this study was to evaluate the ability of this technique to detect cerebral sinuses and veins by means of the occipital window and to provide reference data. METHODS: The straight and inferior sagittal sinuses, great and internal cerebral veins, and basal veins were insonated in 120 normal subjects. The number of identified vessels, peak systolic (PSV) and end-diastolic (PDV) velocities, and resistance indices were determined. RESULTS: In subjects aged 20 to 59 years, straight sinuses were identified in 81% and great and internal cerebral veins in 34%. In subjects aged 60 to 79 years, straight sinuses were detected in 50%, great cerebral veins in 20%, and internal cerebral veins in 13%. All insonated inferior sagittal sinuses and basal veins were missed. Velocities were highest in straight sinuses (PSV, 35 [7 to 64] cm/s; PDV, 23 [2 to 43] cm/s), slower in great cerebral veins (PSV, 23 [12 to 34] cm/s; PDV, 16 [7 to 26] cm/s), and slowest in internal cerebral veins (PSV, 14 [10 to 18] cm/s; PDV, 10 [5 to 15] cm/s) (mean with 95% confidence intervals [CIs]). Straight sinus velocities decreased with age for PSV (20 to 39 years, 40 [7 to 73] cm/s; 60 to 79 years, 28 [9 to 46] cm/s; P < .01) and PDV values (20 to 39 years, 28 [4 to 52] cm/s; 60 to 79 years, 16 [5 to 26] cm/s; P < .001) (mean with 95% CIs) and were higher in women than men in the group aged 20 to 39 years. (P < .05). Resistance indices increased with age in the straight sinus (20 to 39 years, 0.30 [0.18 to 0.42]; 60 to 79 years, 0.42 [0.31 to 0.53]; P < .001) (mean with 95% CIs). CONCLUSIONS: Transoccipital power-based color-coded duplex sonography enabled imaging and velocity measurements in the straight sinus of subjects aged 20 to 59 years. In elder subjects detection rate of the straight sinus decreased, and it was low for deep cerebral veins in all age groups.

Adult↗
PubMedDate not supplied

Radiography and ultrasonography in paranasal sinusitis.

In order to analyze whether ultrasonography with a reasonable degree of confidence can replace radiography in the diagnosis of sinusitis, 138 patients with clinical signs of sinusitis were examined with both methods. It was found that maxillary sinus fluid was recognized ultrasonographically with a confidence that increased with the amount of fluid, judged from radiographic examinations. In a sub-group of 45 cases, fluid confirmed by maxillary sinus puncture was detected by ultrasonography in 35/45 sinuses (78%) and by radiology in 38/45 sinuses (84%). In patients with radiographically normal maxillary sinuses, the correlation to ultrasound was good. However, mucosal swelling and polyps or cysts observed at radiography were poorly demonstrated by ultrasonography. In addition, the ultrasound method was not reliable for frontal sinus diagnosis. It was concluded that ultrasonography can be recommended in maxillary sinusitis for follow-up of treatment and as a screening method before sinus radiography.

Adult↗
PubMed2000

Validity of ultrasonography in diagnosis of acute maxillary sinusitis.

BACKGROUND: Accurate diagnosis of maxillary sinusitis is difficult on the basis of clinical examination only because the signs and symptoms of sinusitis are nonspecific. A simple, rapid, and readily available method for diagnosing maxillary sinusitis in primary care would increase the accuracy of the diagnoses and thus reduce unnecessary antibiotic treatment. OBJECTIVE: To investigate the validity of ultrasonography compared with radiography and magnetic resonance imaging (MRI) in detection of maxillary sinusitis. DESIGN: Ultrasonography and plain-film radiography of the paranasal sinuses were performed on all patients and MRI was performed on 40 randomly selected patients on day 7 of the study. SETTING: Study office at the Department of Pediatrics of Turku University Hospital, Turku, Finland. PATIENTS: One hundred ninety-seven young adults who contacted the study office within 48 hours of the onset of symptoms of the common cold. MAIN OUTCOME MEASURES: Detection rates of maxillary sinusitis by ultrasonography, radiography, and MRI. RESULTS: Acute maxillary sinusitis was diagnosed in 24% of the sinuses by radiography and in 28% by MRI. Compared with MRI findings, the sensitivity of ultrasonography for detection of maxillary sinusitis was 64% (specificity, 95%). Using a 2-step diagnostic approach in which radiological findings were additionally considered in cases of negative ultrasound findings, a sensitivity of 86% (specificity, 95%) was observed. CONCLUSIONS: The high specificity of ultrasonography indicates that a positive ultrasound finding can be regarded as evidence of maxillary sinusitis. The addition of plain-film radiography in cases of negative ultrasound findings increases the diagnostic sensitivity to clinically acceptable levels without loss in specificity. Active use of ultrasonography would substantially decrease the need for radiological imaging of the sinuses and also help reduce unnecessary antibiotic treatment in primary care. Arch Otolaryngol Head Neck Surg. 2000;126:1482-1486

Acute Disease↗
PubMed2006

Meningiomas infiltrating the superior sagittal sinus: surgical considerations of 328 cases.

The aim of the study was to discuss our management strategy and results of patients affected by meningiomas infiltrating the superior sagittal sinus. We describe 328 patients with meningiomas that were infiltrating the superior sagittal sinus. All the patients were surgically treated. Patients with meningioma involving the anterior segment of the sinus underwent total sinus resection. Patients with meningioma that was infiltrating the middle and posterior third of the sinus had a complete sinus removal if the dural sinus was completely obliterated by meningioma and incomplete removal if the sinus was not occluded. The tumour removal was grade I according to Simpson's grading system in 193 cases and grade II or III in the remainder. The superior longitudinal sinus was totally resected in 215 patients and marginally resected in 113. The tumour reappeared in 38 patients. The number of re-interventions did not affect clinical outcome. The extent of removal significantly influenced the regrowth or recurrence rate. Our results suggest that the risks of aggressive surgery, with sinus reconstruction, may be avoided, and conservative surgery for meningiomas that are infiltrating but not obliterating the superior sagittal sinus may be a reasonable choice.

Activities of Daily Living↗